[The quality of diagnostic classification using abridged versions of the tinnitus questionnaire: comparative analysis]. / Diagnostische Klassifikationsgüte von Kurzversionen des Tinnitus-Fragebogens : Vergleichende Analyse.

BACKGROUND: There are different abridged versions of the tinnitus questionnaire (TQ) and reference values for grading tinnitus-related distress, the diagnostic value of which is unclear, as is the relation of sensitivity to specificity, as well as positive and negative predictive values. The present study is aimed at clarifying these issues and at benchmarking the existing abridged TQ versions. PATIENTS AND METHODS: TQ data from 209 outpatients who had tinnitus for a period of at least 4 months were collected at the beginning of treatment. The rate of correct severity ratings, the quality of making a distinction between (extremely) severe and compensated/moderate tinnitus (area-under curve under the receiver-operating-characteristics curve, and rate of correct classifications), as well as positive and negative predictive values were calculated. RESULTS: Applying unspecific reference values (independent of inpatient/outpatient status), the most favourable evaluation was achieved by the shortest TQ version (10 items). With the 12-item version (mini-TQ), better classification was achieved when reference values specific for outpatients were applied instead of unspecific values.

[Value of informed consent in tympanoplasty and FESS procedures]. / Zum Erinnerungsvermögen an das präoperative Aufklärungsgespräch bei HNO-Patienten.

BACKGROUND: More than one third of all lawsuits against surgeons include statements of insufficient or lacking preoperative informed consent which is mandatory in the german jurisprudence. Almost nothing is known about the postoperative patient's memory of risk factors which were explained prior to typical surgical procedures in ENT. METHODS: The objectives of this prospective study in 201 patients were to elucidate the actual clinical routine of obtaining informed consent for tympanoplasty (n=105) and FESS procedures (n=89), collect information on active and passive recall 6 weeks, 6 months and 1 year post-operatively, and to investigate whether patient age, sex, education, the time from obtaining consent to interview, recurrent vs. non-recurrent procedures, would influence the patient's recall capabilities. RESULTS: In clinical routine, obtaining informed consent included 5 main items for tympanoplasty and 5 for FESS procedures made by the physician. Of the patients, 18.9% recalled actively and 65.3% passively. They named 1.5 items on average, with "deafness" as the leading complication in tympanoplasty and "amaurosis" in FESS procedures. Patient's memory was depending on the time from obtaining consent to interview and education exclusively. CONCLUSION: In conclusion, the quantity of patient/physician interaction does not guarantee an increased effect on patient's recall. Improving patient interaction may reduce the probability of imminent accusations.

[Distraction and relaxation training in acute tinnitus : effects of a complement to otorhinolaryngological treatment]. / Ablenkungs- und Entspannungstraining bei akutem Tinnitus : Effekte einer Ergänzung HNO-ärztlicher Behandlung.

BACKGROUND: We examined whether training conceptualized as a complement to standard medical treatment (ST) for acute tinnitus to promote patients' capacity to distract attention from their tinnitus and to relax (distraction and relaxation training) has a positive effect on tinnitus-specific distress (tinnitus loudness, tinnitus-related distress and disability), as well as on general well-being. PATIENTS AND METHODS: Study participants comprised 29 patients with tinnitus of maximum 4 weeks' standing (first lifetime tinnitus episode) who were randomized to ST (rheological therapy) or advanced standard treatment (AST) (rheological therapy complemented by distraction and relaxation training). RESULTS: Tinnitus-specific distress was reduced to a significantly greater extent in the EST group as compared to ST, especially in patients with a striking psychopathology. The improvement in general well-being was comparable in both groups. CONCLUSION: In acute tinnitus, distraction and relaxation training should be conducted as a complement to standard medical treatment, especially in high-risk patients demonstrating abnormal psychopathological status, since treatment results can be improved in this way.

[Update: catheter-based balloon dilatation of the sinuses without fluoroscopy. Dilation technique with an illumination system]. / Update: Die kathetergestützte Ballondilatation der Sinusostia ohne Röntgendurchleuchtung. Dilatationstechnik mit Hilfe eines Beleuchtungssystems.

BACKGROUND: Catheter-based balloon dilation of the sinus ostia follows the general guidelines for functional endoscopic sinus surgery with the goal of reopening the sinus ostium to restore ventilation and drainage of the sinus and reestablish normal mucosal function, while maintaining normal mucosal tissue and avoiding scar tissue formation. A main criticism of this procedure questions the necessity of fluoroscopy with the C-arm since its use exposes patients and medical personnel to radiation and the C-arm is not available in every ENT operating room. MATERIAL AND METHODS: Catheter-based balloon dilation of the sinus ostia was performed with the Relieva Luma Sinus Illumination System (Acclarent, Inc.) without fluoroscopy. RESULTS: Using this method of illumination, it was possible to localize the device tip transcutaneously in the maxillary and frontal sinus cavities, making radiological exposure unnecessary. CONCLUSION: The advantages of catheter-based balloon dilation without fluoroscopy lie in the elimination of radiation exposure to the patient and personnel as well as the cost savings. Randomized controlled trials should be planned to further evaluate this technique.

[Catheter-based balloon dilatation of the frontal, maxillary, and sphenoid ostia: a new procedure in sinus surgery]. / Kathetergestützte Ballondilatation des Ostium frontale, maxillare und sphenoidale: Ein neues Verfahren in der Nasennebenhöhlenchirurgie.

BACKGROUND: Endoscopic sinus surgery is the procedure of choice for treating chronic rhinosinusitis. This paper describes a new minimally invasive method to restore ostium patency without removing tissue: the balloon sinuplasty technique. PATIENTS AND METHODS: Two patients were treated with the new procedure. One patient had her maxillary and sphenoid ostia dilated; the other patient had both frontal ostia, both maxillary ostia, and the right sphenoid ostia dilated. RESULTS: The balloon dilatations of the ostia were achieved successfully without impairing the mucosal circumference. There was no bleeding, and nasal packing was not necessary. The postoperative healing process showed no complications. CONCLUSION: This paper discusses the advantages and disadvantages as well as the indications and contraindications of this method. The balloon sinuplasty technique is an easily performed surgery; for selected indications, it seems especially suited for opening blocked ostia.

Malignant ectomesenchymoma of the nose. Case report and review of the literature.

To the best of our knowledge, a malignant ectomesenchymoma of the nose has not yet been reported. This rare tumour is composed of a mesenchymal element--usually a rhabdomyosarcoma--and a neuroectodermal element, often a neuroblastoma or a malignant schwannoma. Most malignant ectomesenchymomas have been found in children (mainly boys), but 5 adult cases, including our case, have also been reported. A 62-year-old man presented with a nasal obstruction on the right side of the nose. Diagnostic nasal endoscopy revealed a mass in the dorsal part of the right nasal cavity, which was treated by endoscopic surgery. The postoperative course was uneventful, and subsequent radiotherapy well tolerated. Since rhabdomyosarcoma is the most common component of this neoplasm, the treatment protocol for rhabdomyosarcoma would have appeared appropriate. This report reviews the literature, summarises the pathological features and possible histogenesis of the tumour, and outlines recommended treatments for malignant ectomesenchymoma.

[Oncocytic adenocarcinoma of the submandibular gland]. / Onkozytäres Adenokarzinom der Glandula submandibularis.

BACKGROUND: Malignant oncocytic tumors rarely occur in major salivary glands and generally account for < 1% of all salivary tumors. There is no difference of both sexes and appearing mainly between 50 and 60 years of age. They comprise oncocytes, which are epithelial cells with abnormally formed cytoplasm and acidophilic granular cytoplasma. In the process of the malignant transformation the coexistence from oncocytic rests and untypical oncocytic carcinoma portions can be seen. The tumors show no capsule and an infiltrative local growth with perineural and vascular expansions. PATIENT AND METHOD: A rare case of a 59-year-old man with malignant oncocytoma is presented. The tumor was found in the left submandibular gland with one enlarged lymph node near by. RESULT AND CONCLUSIONS: A general overview of the available literature and the histological classification of oncocytomas is given. Therapy consists of surgical resection and radiotherapy. Close clinical controls are necessary.

Binding specificity of Escherichia coli trigger factor.

The ribosome-associated chaperone trigger factor (TF) assists the folding of newly synthesized cytosolic proteins in Escherichia coli. Here, we determined the substrate specificity of TF by examining its binding to 2842 membrane-coupled 13meric peptides. The binding motif of TF was identified as a stretch of eight amino acids, enriched in basic and aromatic residues and with a positive net charge. Fluorescence spectroscopy verified that TF exhibited a comparable substrate specificity for peptides in solution. The affinity to peptides in solution was low, indicating that TF requires ribosome association to create high local concentrations of nascent polypeptide substrates for productive interaction in vivo. Binding to membrane-coupled peptides occurred through the central peptidyl-prolyl-cis/trans isomerase (PPIase) domain of TF, however, independently of prolyl residues. Crosslinking experiments showed that a TF fragment containing the PPIase domain linked to the ribosome via the N-terminal domain is sufficient for interaction with nascent polypeptide substrates. Homology modeling of the PPIase domain revealed a conserved FKBP(FK506-binding protein)-like binding pocket composed of exposed aromatic residues embedded in a groove with negative surface charge. The features of this groove complement well the determined substrate specificity of TF. Moreover, a mutation (E178V) in this putative substrate binding groove known to enhance PPIase activity also enhanced TF's association with a prolyl-free model peptide in solution and with nascent polypeptides. This result suggests that both prolyl-independent binding of peptide substrates and peptidyl-prolyl isomerization involve the same binding site.

Bag-1M accelerates nucleotide release for human Hsc70 and Hsp70 and can act concentration-dependent as positive and negative cofactor.

The cytosol of mammalian cells contains several Hsp70 chaperones and an arsenal of cochaperones, including the anti-apoptotic Bag-1M protein, which regulate the activities of Hsp70s by controlling their ATPase cycles. To elucidate the regulatory function of Bag-1M, we determined its influence on nucleotide exchange, substrate release, ATPase rate, and chaperone activity of the housekeeping Hsc70 and stress-inducible Hsp70 homologs of humans. Bag-1M and a C-terminal fragment of it are potent nucleotide exchange factors as they stimulated the ADP dissociation rate of Hsc70 and Hsp70 up to 900-fold. The N-terminal domain of Bag-1M decreased the affinity of Bag-1M for Hsc70/Hsp70 by 4-fold, indicating a modulating role of the N terminus in Bag-1M action as nucleotide exchange factor. Bag-1M inhibited Hsc70/Hsp70-dependent refolding of luciferase in the absence of P(i). Surprisingly, under physiological conditions, i.e. low Bag-1M concentrations and presence of P(i), Bag-1M activates the chaperone action of Hsc70/Hsp70 in luciferase refolding. Bag-1M accelerated ATP-triggered substrate release by Hsc70/Hsp70. We propose that Bag-1M acts as substrate discharging factor for Hsc70 and Hsp70.

Tuning of chaperone activity of Hsp70 proteins by modulation of nucleotide exchange.

The Hsp70 chaperone activity in protein folding is regulated by ATP-controlled cycles of substrate binding and release. Nucleotide exchange plays a key role in these cycles by triggering substrate release. Structural searches of Hsp70 homologs revealed three structural elements within the ATPase domain: two salt bridges and an exposed loop. Mutational analysis showed that these elements control the dissociation of nucleotides, the interaction with exchange factors and chaperone activity. Sequence variations in the three elements classify the Hsp70 family members into three subfamilies, DnaK proteins, HscA proteins and Hsc70 proteins. These subfamilies show strong differences in nucleotide dissociation and interaction with the exchange factors GrpE and Bag-1.

[Schwannoma of the tongue]. / Das Schwannom der Zunge.

BACKGROUND: Schwannoma, in the English literature mostly called neurilemmoma, are well known in the ear-nose-and-throat-medicine as benign tumors of the nerve-sheath, for example as neuroma of the acoustic nerve. They are seldom found at other peripheral nerves of the head. The localisation in the tongue has so far only been described in some individual cases. CASE REPORT: We present a case of a 28-year-old woman with a schwannoma of the tongue, measuring 4.0 x 2.2 x 3.2 cm. The case history and the radiological investigations suggested a malignant tumor. During the operation the lump revealed itself as being encapsulated. Under the histological examination it was discovered to be a Schwannoma. CONCLUSIONS: We would like to add a further case of a schwannoma of the tongue to the so far published cases, thus allowing this possibility to be considered in general diagnosis.

[Ear dysfunction due to air bag detonation?]. / Funktionsstörungen des Hörorgans nach Airbagdetonationen?

Air bags are among the latest developments in extensive automobile safety systems. They successfully have saved the lives of car occupants in road accidents. Many additional injuries caused by air bags from minor to severe have been reported. With the help of two acceleration sensors, the electronic tuner amplifier records the vehicle's deceleration. This is the adequate trigger for air bag deployment, which creates an intense noise of up to 170 dB sound pressure level. This noise level can cause cochlear damage. We present two patients with otologic symptoms after spontaneous air bag deployment.

[Intraductal papilloma of the parotid gland]. / Das intraduktale Papillom der Glandula parotis.

BACKGROUND: This rare intraductal papilloma of the salivary glands is classified as an adenoma of the subgroup ductal papillomas. The nature of intraductal papillomas has not been fully researched. It is assumed that the intraductal papilloma arises from the excretory duct reserve cell population. Since the lesion was first described, 9 cases have been reported. CASE REPORT: An additional case of intraductal papillomas of the parotid gland is presented: a 62-year-old woman with a solid and well displaceable tumor of the left preauricular region. After a standard superficial parotidectomy was performed the histological examination revealed an intraductal papilloma. RESULT AND CONCLUSION: The case represents the first published case in German literature. This study presents a review of the literature and a discussion of the histopathologic characteristics and possible histogenesis of the intraductal papilloma. Regular follow-up has not revealed any recurrence of the disease 15 months after resection. The treatment of choice is local excision or removal.

[Diagnosis of postoperative dysphagia and aspiration. Fiberoptic-endoscopic controlled methylene blue drinking]. / Zur Diagnostik der postoperativen Dysphagie und Aspiration. Fiberoptisch-endoskopisch kontrollierter Methylen-Blauschluck.

Postoperative swallowing disorders are common after such function-preserving surgery as conventional resections or endoscopic laser procedures for carcinomas of the larynx and hypopharynx. In most cases a reduction in motility of the pharyngeal muscles and sensory impairment of the pharyngeal and laryngeal regions can occur because of postoperative tissue abnormalities, including scarring due to the healing process. We have used fiberoptic endoscopic examinations with methylene blue to analyze postoperative swallowing and observe whether staining or aspiration occurs. By so doing, we have improved postoperative swallowing in 25 patients after extended surgery for cancer and were able to detect or exclude aspiration. The advantages of this minimally invasive, non-stressful diagnostic procedure are discussed and can be important for further successful care after surgery.

[Incidence of endomycoses in the autopsy material of the Berlin Charité Hospital]. / Vorkommen von Endomykosen im Obduktionsgut der Berliner Charité.

From 1970 to 1993, a total of 93 endomf1p4es confirmed by post-mortem examination was diagnosed in the autopsy material of the Berlin Charité, a large hospital with an average of 1,500 hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.6%), five cryptococcoses (5.4%), one zygomycosis, 1 trichosporosis and one coccidioidomycoses. This corresponded to 0.7% of the 13,375 decreased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis [11 candidoses (39.3%), 10 aspergilloses (35.7%), five cryptococcoses (17.9%), one trichosporosis and one coccidioidomycosis]. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. Against the background of the continuing reduction in the frequency of autopsy in the Federal Republic of Germany, the observations made in the present paper underscore the demand for improved efficiency of mycological in-vivo diagnoses in the hospital and laboratory.

Effect of cyclosporin A on carbohydrate metabolism in the rat.

Liver and kidney carbohydrate metabolism was investigated in rats treated with daily doses of 15 mg/kg body weight cyclosporin A (CyA) for 2 and 8 weeks or of 50 mg/kg body weight CyA for 2 weeks. The higher dosage caused significantly reduced liver glycogen and liver glycogen synthetase activity (of both active I-form and total enzyme activity), whereas the activity of the glycogen-degrading enzyme phosphorylase (active a-form and total activity) remained unchanged. Plasma glucose and glucagon levels, as well as blood ketone bodies of these animals, increased significantly and plasma insulin decreased. In contrast, kidney glycogen and glucose content were higher in rats treated with 50 mg CyA, probably due to enhanced ketone body utilization. Reduced liver glycogen synthetase activity was also found in rats treated with 15 mg CyA. Our data suggest that hypoinsulinemia, induced by CyA, might be a contributing factor to the hyperglycemia, which is mainly due to inhibition of liver glycogen synthesis.